Efficacy of Ankle Arthodesis with Retrograde Sign Nail

Aim: To evaluate the efficacy of ankle arthrodesis by using Retrograde SIGN Nail. Study Design: Retrospective study. Place and Duration of the Study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2018 to 30th June 2020. Methodology: Thirty patients were enrolled for arthrodesis by using retrograde nails. Clinical and radiological examination confirmed the severe arthritis of the subtalar joints in all cases. Surgical procedure was initiated by using lateral incision fibula segment of 1.5 cm was excised 6-8 cm proximal to the fibula tip. After adequate exposure, from proximal lateral to distal medial, approximately 5-6 cm transaction of the fibula was made obliquely. Soft tissue was the initiating point of dissection and the portion was placed on the back table for further use as an autogenous bone graft. To expose the medial gutter, approximately 2-3 cm incision was carefully made at medial to the tibialis anterior tendon without indulging saphenous nerve and vein. Results: A weak positive Pearson correlation was found between BMI and FAAM score but a significant (P=0.00001). Conclusion: Retrograde nailing techniques help to achieve the goals of the union. It also assists in the preservation of hind foot alignment. Keywords: Ankle deformity, Ankle arthrodesis, Ankle arthritis, Retrograde nailing

BANDHANA WITH MANJISHTADI LEPA IN THE MANAGEMENT OF ANKLE SPRAIN – A CASE REPORT

The ankle joint is the most common site for a ligament injury in the body. Some ankle joint injuries are minor and heal with some rest from activities, but some are serious and require immediate medical attention. An ankle sprain refers to ligament injuries of the ankle. In classics, there is no direct reference regarding sprain and its manage- ment. In Susrutha Samhitha Chikitsa Sthana 3rdchapter, Bhagna Chikitsitham, Acharya Susruta has mentioned the application of Manjishtadi Lepa for traumatic joint injuries. In the present case study, a 22 years old male pa- tient visited the OPD with severe pain and swelling of the right ankle following a twisting injury of the foot. He was diagnosed with a grade 1 ankle sprain and was bandaged with Manjishtadi Lepa. Management with Man- jishtadi Lepa has shown significant relief in pain and swelling as well as in the restoration of normal movements. Keywords: Ankle sprain, Manjishtadi Lepa

Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report

Introduction: Stenosing tenosynovitis is a chronic disorder frequently observed in finger triggering of a digit. Regarding the toes, although entrapment of the flexor hallucis longus (FHL) has already been reported in a few cases among sports players, the clinical condition is uncommon. Besides, the case without any specific causes is particularly rare. Case Report: We report the case of a 26-year-old male with FHL entrapment. Even though he was unaware of any cause, he felt tenderness on the posteromedial side of his left ankle, and his great toe was locked in the flex position. Magnetic resonance imaging indicated effusion in the tendon sheath of the FHL and the possibility of a partial tear of the FHL. We hypothesized that the scar tissue secondary to the partial tear of the FHL may have been irritated at the retrotalar pulley below the sustentaculum tali, where the FHL glides. Therefore, posterior ankle arthroscopy was performed for the treatment of the FHL entrapment. Conclusion: Orthopedic surgeons should list this pathology as a differential diagnosis of posterior ankle pain, even in non-athletes. Keywords: ankle arthroscopy, flexor hallucis longus, stenosing tenosynovitis.

GAMBARAN NILAI ANKLE BRACHIAL INDEX (ABI) PADA PENYANDANG DM TIPE 2 DI PUSKESMAS GUNUNGSARI LOMBOK BARAT

ABSTRACT: THE ANKLE BRACHIAL INDEX AMONG PATIENTS WITH TYPE 2 DIABETES IN WEST LOMBOK-INDONESIABackground: Diabetes spreads throughout the provinces in Indonesia. One of them in the Province of West Nusa Tenggara (NTB), the prevalence of DM diagnosed is 0.9% of the total population. Peripheral vascularization disturbance that occur in people with DM need to be known from the beginning. One effort to determine the existence of disorders peripheral vascularization is by examining the ankle brachial index (ABI).Purpose: To determine the description of the value of the Ankle Brachial Index (ABI) of people with DM in the DM group.Methods: Descriptive study with a population of 25 patients with a total sampling technique. The instrument used is the observation sheet.Results: Most women with DM were as many as 17 patients (68%), most people with DM at the age of 46 - 55 years (68%), the value of ABI with DM with normal interpretations of the right ABI 22 patients (88%) and left ABI 23 patients (92%), right borderline perfusion ABI occurred at the age of 56 - 65 years as many as 2 patients (66.7%), borderline perfusion left ABI occurred at the age of 56-65 years as many as 2 patients (100%), borderline perfusion Right ABI occurred in 2 female respondents (66.7%), borderline perfusion left ABI occurred in female respondents as many as 2 patients (100%).Conclusion: In an effort to improve the health status of the community, especially DM persons, it is expected that the Gunung Sari Health Center in West Lombok Regency can control people with DM in participating in the Puskesmas program, especially DM. Keywords: Ankle Brachial Index (ABI), Type 2 Diabetes Pendahuluan: Penyakit diabetes menyebar diseluruh provinsi di Indonesia. Salah satunya di Provinsi Nusa Tenggara Barat (NTB), prevalensi DM yang sudah terdiagnosis adalah 0,9% dari jumlah total penduduk. Gangguan vaskularisasi perifer yang terjadi pada penyandang DM perlu diketahui dari awal. Salah satu upaya untuk mengetahui adanya gangguan vaskularisasi perifer adalah dengan melakukan pemeriksaan ankle brachial index (ABI).Tujuan : Mengetahui gambaran nilai Ankle Brachial Index (ABI) penyandang DM pada kelompok penyandang DM.Metode : Penelitian deskriptif dengan populasi 25 pasien dengan teknik pengambilan sampel total sampel. Instrumen yang digunakan adalah lembar observasi.Hasil penelitian: Penyandang DM terbanyak dialami oleh perempuan yaitu sebanyak 17 pasien (68%), penyandang DM terbanyak pada usia 46 – 55 tahun (68%), nilai ABI penyandang DM dengan interpretasi normal ABI kanan 22 pasien (88%) dan ABI kiri 23 pasien (92%), borderline perfusion ABI kanan terjadi pada usia 56 – 65 tahun yaitu sebanyak 2 pasien (66,7%), borderline perfusion ABI kiri terjadi pada usia 56-65 tahun sebanyak 2 pasien (100%), borderline perfusion ABI kanan terjadi pada responden perempuan sebanyak 2 pasien (66,7%), borderline perfusion ABI kiri terjadi pada responden perempuan sebanyak 2 pasien (100%).Simpulan: Dalam upaya untuk meningkatkan derajat kesehatan masyarakat khususnya penyandang DM diharapkan Puskesmas Gunung sari Kabupaten Lombok Barat, dapat mengontrol penyandang DM dalam mengikuti program puskesmas khususnya DM.

Effectiveness of Surgical Management of Ankle Fractures in Attaining the Stability of Ankle

Introduction: Ankle injuries comprise a major group of lower limb trauma. Many of these injuries can be treated by manipulative reduction and conservative treatment and some of these yield satisfactory results, so present study was undertaken to know the effectiveness of surgical management of ankle fractures. Method: 42 surgically treated displaced fractures are included and studied in detail of age, sex, occupation, type of fracture, mode of injury, type of treatment, Clinical evidence of fracture union, Radiological evidence of fracture union, Relation of talus in the ankle mortise, Range of mobility of the ankle, Residual disability and pain, Ability to walk and time of return to duty and complications were noted. Result: 42 cases were surgically treated, most of the patients were operated on an emergency basis within 24 hours of injury. Based on the mechanism of injury Pronation- External Rotation (30.9%) and Based on Ao Classification Type B - B2 (53.3%) were the major type of fractures. In the majority of cases, Malleolar screws type of implants used. In overall the final status of patients is good (ability to walk). Conclusion: Displaced ankle fractures need accurate open reduction and internal fixation and postoperative immobilization for 6 weeks. This will suffice to get good results. Post-operative rigid immobilization and protected weight bearing for 12 weeks is minimal to achieve good union followed by physiotherapy to restore the maximum range of movements Keywords: Ankle Fractures; Surgical management, Stability; Effectiveness.

Towards Optimal Platform-Based Robot Design for Ankle Rehabilitation: The State of the Art and Future Prospects

This review aims to compare existing robot-assisted ankle rehabilitation techniques in terms of robot design. Included studies mainly consist of selected papers in two published reviews involving a variety of robot-assisted ankle rehabilitation techniques. A free search was also made in Google Scholar and Scopus by using keywords “ankle∗,” and “robot∗,” and (“rehabilitat∗” or “treat∗”). The search is limited to English-language articles published between January 1980 and September 2016. Results show that existing robot-assisted ankle rehabilitation techniques can be classified into wearable exoskeleton and platform-based devices. Platform-based devices are mostly developed for the treatment of a variety of ankle musculoskeletal and neurological injuries, while wearable ones focus more on ankle-related gait training. In terms of robot design, comparative analysis indicates that an ideal ankle rehabilitation robot should have aligned rotation center as the ankle joint, appropriate workspace, and actuation torque, no matter how many degrees of freedom (DOFs) it has. Single-DOF ankle robots are mostly developed for specific applications, while multi-DOF devices are more suitable for comprehensive ankle rehabilitation exercises. Other factors including posture adjustability and sensing functions should also be considered to promote related clinical applications. An ankle rehabilitation robot with reconfigurability to maximize its functions will be a new research point towards optimal design, especially on parallel mechanisms.

THE COMPARISON OF ANKLE BRACHIAL INDEX IN PATIENTS WITH AND WITHOUT ACS IN PROF. DR. R. D. KANDOU HOSPITAL, MANADO

Abstrak: Walaupun merupakan pengukuran sederhana dan non-invasif, ankle brachial index (ABI) menunjukkan sensitifitas dan spesifisitas yang tinggi dalam mendiagnosis penyakit arteri perifer pada nilai ABI ≤0,9. ABI juga merupakan indikator yang kuat untuk mengetahui penyakit aterosklerosis pada area vaskular lainnya. Penelitian ini bertujuan untuk menentukan perbandingan antara ABI pada pasien dengan atau tanpa sindroma koroner akut (SKA). Penelitian ini menggunakan analisis analitik observasional dengan desain potong lintang. Subyek penelitian ialah pasien dengan SKA dan pasien tanpa SKA yang datang ke Departemen Kardiologi dan Pembuluh Darah RSU Prof. Dr. R.D Kandou, Manado bulan September-Desember 2012. Nilai normal ABI yaitu >0,9 dan <1,4, sedangkan ABI <0,9 perlu dipertimbangkan abnormal. Nilai ABI >1,4 dipertimbangkan tidak valid dan diekslusi. Hubungan antara variabel dievaluasi menggunakan SPSS. Hasil penelitian memperlihatkan 33 pasien SKA (72,8% laki-laki) dan 33 pasien tanpa SKA (81,8% laki-laki) sebagai subyek penelitian. Rerata usia pasien SKA 57 tahun dan tanpa SKA 52,3 tahun. Angka kejadian pasien SKA dengan ABI abnormal lebih tinggi, yaitu 82,1% vs 17,9% (P < 0,001). Uji chi-square menunjukkan terdapatnya hubungan antara SKA dan peningkatan risiko ABI abnormal (OR 12, P < 0,05). Simpulan: Sindroma koroner akut berhubungan dengan peningkatan risiko dari ABI abnormal. Kata kunci: Ankle brachial index, sindroma koroner akut. Abstract: Although the ankle-brachial index (ABI) is a simple and non-invasive measurement, it shows a high sensitivity and specificity in the diagnosis of peripheral arterial disease (PAD) when its value is ≤0.9. Moreover, ABI is a powerful indicator of atherosclerotic diseases in other vascular areas. This study aimed to determine the comparison between ankle brachial indices (ABI) in patients with or without acute coronary syndrome (ACS). This was an analytical observational study with a cross sectional design. We measured ABI indices in 33 patients with ACS and 33 patients without ACS admitted to the Department of Cardiology and Vascular Medicine, Prof. Dr. R.D. Kandou Hospital, Manado. The normal ABI is >0.9 and <1.4. However, ABI <0.9 was considered as abnormal. On the other hand, ABI >1.4 was considered invalid and then excluded. The association of variables was evaluated by SPSS software. The results showed that there were 33 ACS patients (72.8% male) and 33 patient without ACS (81.8% male). ACS patients were older (57 vs 52.3 years). ACS patients had more prevalent abnormal ABI (82.1% vs 17.9%; P < 0.001). Chi square test showed that ACS was associated with an increased risk of abnormal ABI (OR 12, P < 0.05). Conclusion: ACS was associated with an increased risk of abnormal ABI. Keywords: ankle brachial index, acute coronary syndrome.

Use of the Ottawa Ankle Rule by paramedics in the out-of-hospital setting

Introduction The Ottawa Ankle Rule (OAR) is extensively documented in the emergency department setting and has been subjected to repeated validation. However, the prehospital experience in implementing this clinical decision rule appears poorly described. The objective of this study is to identify evidence (of any level) describing the use of the OAR by paramedics. Methods A literature search was conducted of the following key electronic databases; Medline (1950 to March Week 1 2010); EMBASE (1980-Week 10 2010) and CINAHL (1981-March 2010). The keywords 'ankle injury', 'clinical decision rule', 'paramedic', 'ambulance', 'prehospital', and 'emergency care' were used to frame the search, while a prehospital and emergency care search filter was used to maximise the sensitivity of the search. A review was conducted of the reference lists accompanying each relevant article to identify other potentially relevant citations. The search criteria included published articles which were both primary research and secondary review papers, and conference abstracts of any research design. We excluded non-English articles and letters. The abstracts of all citations in the search results were reviewed and full text articles for studies of interest were retrieved for examination. Results The search yielded 98 citations, with 80 relating directly to the OAR. After reviewing the abstracts of all citations, no articles of any study design, discussing the use of the OAR by paramedics in the out-of-hospital setting were identified. Conclusion Whilst there is no published evidence describing the use of the OAR by paramedics in the prehospital setting, it is feasible that paramedics could implement the rule safely and with equivalent sensitivity and specificity to other settings. This clinical decision rule may have good utility as a triage tool that could be used to stream suitable patients into non-emergency department alternatives. Research is needed to validate the use of the OAR when used within EMS jurisdictions.